Presented at the Neonatal Society 2001 Autumn Meeting.
Howells RJ1, Mekhael HF2, Madar JD1, Freeman R2
1 Department of Child Health, Derriford Hospital, Plymouth, PL6 8DH
2 Department of Obstetrics and Gynaecology, Derriford Hospital, Plymouth, PL6 8DH
Purpose of Study: Planned caesarean sections, when deferred until the 39th week of gestation, are associated with less neonatal morbidity when compared to those which are undertaken within the 37th-38th weeks of gestation (1,2). The purpose of this study was to determine whether deferred surgery was associated with onset of labour prior to elective delivery, or with complications following unexpected vaginal / emergency caesarean section.
Methods: We conducted a retrospective, observational study of all elective caesarean sections booked for 39 weeks’ gestation at a district general hospital over a one-year period.
Results: 4319 women delivered 4385 babies in 1998. 246 women were booked for elective caesarean section at term (5.7% of all deliveries), all at =39 weeks. 223 (90.6%) of these caesarean sections occurred at the allocated time. In 17 of the remaining 23 pregnancies, spontaneous labour occurred prior to the appointed date. 3/17 resulted in vaginal delivery, and 12 in ‘non-emergency’ caesarean section. Two ’emergency’ caesarean sections were undertaken. The remaining six pregnancies were delivered early in the absence of labour. Complications occurred in 18 of the 23 pregnancies; these were mainly administrative in nature. Two mothers and two babies experienced medical complications, but these occurred before 37 weeks and were not a direct result of deferred surgery. No long-term complications occurred.
Conclusions: Deferring caesarean section from =37 to =39 weeks is not associated with increased maternal or neonatal morbidity. However, increased numbers of emergency caesarean sections during this interval may impact upon out-of-hours staff.
References
1. Morrison JJ, Rennie JM, Milton PJ. Br J Obstet Gynaecol 1995;102:101-6
2. Madar J, Richmond S, Hey E. Acta Paediatrica 88:1244-8;1999